(PS12-77) Leveraging Gamification to Improve Real-world Behavior: A Randomized Controlled Trial of Joon, an Innovative Behavior Management Platform, for Parents and Children

Behavior therapy, an evidence-based intervention for school-age youth with behavior problems, has decades of work supporting its use (Wolraich et al., 2019). Despite this, the majority of families in need of these services either fail to receive treatment or dropout prematurely (Chacko et al., 2016) leading to the development of novel approaches, including technological approaches, to facilitate access to care. For example, a recent meta-analysis of digitally delivered parenting interventions showed significant effects on child behavior (Baumel et al., 2016) highlighting their potential.

Joon (joonapp.io), developed by Joon Health, is the first digital platform to integrate virtual game-play into the development and implementation of a real world behavioral contingency management system. Specifically, this is accomplished through assigned "quests" that the parent inputs in their mobile device. The child can then see these quests on their device and complete them. Once the parent approves that these have been completed, the child earns coins that can be used to advance in a video game they can access on their mobile device.

Joon Health has partnered with researchers at New York University (NYU) to conduct an 8-week RCT in 100 families of school-age children (6-12 years) with elevated symptoms of disruptive behavior problems who may be at-risk for disorders such as ADHD or ODD. This RCT examines the impact of Joon on parent-reported disruptive behavior symptoms (as measured by the DBD; Pelham, Gnagy, Greensale, & Milich, 1992), executive functioning (EF; as measured by BRIEF-2; Gioia et al., 2015), and functional impairment (as measured by IRS - Parent; Pelham, Fabiano, & Massetti, 2005) relative to a well-designed attention control condition. Participants will be randomized to receive either: 1) the Joon behavior management platform in which children receive digital points in the game for exhibiting improvements in assigned behavior targets in real life (intervention condition) or 2) a modified version of the Joon behavior management platform in which children receive points that are not contingent on their behavior and parents receive general reading material regarding child developmental psychopathology (placebo control condition). Regardless of condition, they will be asked to use the application at least once per day for eight weeks and adherence will be monitored and supported by research study staff.

Results are anticipated by the time of the conference. The outcomes described above will be collected at baseline, after 4 weeks of use (mid-point), and after 8 weeks of use (post-intervention). Multilevel models in R will be used to examine changes across the three time points in each group with an interaction between group (intervention; control) and time (baseline; mid-point, post-intervention) as the primary effect of interest. It is expected that those receiving Joon will exhibit significantly greater improvements in symptoms of DBD, EF, and impairment relative to those receiving the attention control condition. Implications for existing clinical approaches to managing behavior problems in youth will be discussed as well as additional opportunities for future work surrounding the use of digital mental health interventions.